Endoscopic suction instrument having variable suction strength capabilities

ABSTRACT

An endoscopic suctioning instrument with variable suction is disclosed. The instrument has a hollow cannula having a proximal end and a distal end, and sliding sleeve having a proximal end and a distal end and a longitudinal axis, with the sliding sleeve being coaxial to and closely surrounding and slidingly engaging the hollow cannula. The sliding sleeve has a plurality of lateral holes at its distal end with the lateral holes being spaced along the longitudinal axis. A valve is provided for selectively coupling a suction source to the proximal end of the cannula, and a sleeve actuation mechanism is provided for sliding the sliding sleeve from a first position where the distal end of the sliding sleeve extends beyond the distal end of the cannula such that a first number of the lateral holes are unblocked by said cannula, to a second position where the distal end of the sliding sleeve extends beyond said distal end of the cannula such that fewer lateral holes are unblocked by said cannula, to a third position where the cannula blocks all of said lateral holes of the sliding sleeve. Various embodiments are described with different mechanisms for causing the sleeve to slide, including mechanisms linking the valve to the sleeve.

BACKGROUND OF THE INVENTION

This invention broadly relates to endoscopic instruments. Moreparticularly, this invention relates to a multifunction endoscopicinstrument including suction, irrigation and electrocautery means.

Tools having both suction and irrigation features are well known in theart. Perhaps the earliest combination tool of this type is shown in U.S.Pat. Number 1,114,268 to Kells which discloses a "Method For SurgicallyCleansing Wounds and Other Surfaces" where an irrigation tube enters asuction tube and the suction tube is covered with gauze or a swab.Irrigation fluid wets the gauze or swab and is sucked back by thesuction tube. Rubber hoses may be grasped to control flow. Variations onthis type of device include one shown in U.S. Pat. No. 3,810,471 toTruhan which discloses a "Surgical Aspirating Cannula". This is acombined irrigation-suction device where the suction tube is locatedwithin and is coaxial with the irrigation tube, and irrigation fluid isdelivered in the annular space between the tubes. The distal end of theouter irrigation tube is sealed to the inner suction tube and theirrigation tube is provided with lateral openings. Even more recently,additional features have been added to combined suction-irrigationtools. U.S. Pat. No. 4,617,013 to Betz discloses a "Method and ApparatusFor Surgical Irrigation, Aspiration and Illumination" having coaxialfiber optic, aspiration and irrigation tubes.

Tools combining suction and cautery features are also well known in theart and an early tool of this type is shown in U.S. Pat. No. 2,888,928to Seiger which discloses a "Coagulating Surgical Instrument" wherecombined cauterizing and suction is provided by a hollow tube cauteryprobe to which a suction tube is attached. The cauterizing tip isconical with a small opening at the apex of the cone and several lateralopenings spaced down from the apex. More recent improvements in thistype of tool are shown in U.S. Pat. No. 4,307,720 to Weber whichdiscloses an "Electrocautery Apparatus and Method and Means for Cleaningthe Same". This is a combination cautery-suction device where electrodeand vacuum tubes are arranged parallel to each other in the same "wand".The electrode is retractable into the wand and retraction of theelectrode scrapes the surface of the electrode to clean it. Othervariations of this type of tool include yet other features. U.S. Pat.No. 4,207,874 to Choy discloses a "Laser Tunneling Device" which is aprobe for a tube such as a blood vessel. The probe includes centralfiber optics for illumination, viewing, and laser output surrounded by acoaxial tube with a switchable valve for aspiration or irrigation.

More recently, suction, irrigation, and cautery have been combined inthe same tool. U.S. Pat. No. 4,886,491 to Parisi et al discloses a"Liposuction Procedure with Ultrasonic Probe" which includes ultrasoniccautery, suction and irrigation in the same probe.

While many of the tools of the prior art served a purpose at the timethey were invented, they are generally inapplicable in today's modernendoscopic surgical procedures. An endoscopic procedure typicallyinvolves the use of trocars for making one or more small incisions inthe abdomen or chest cavity. Trocar tubes are then left in place in theabdomen or chest cavity so that optical tools may be insertedtherethrough for viewing and endoscopic surgical tools may be insertedtherethrough for operating. A camera or magnifying lens optical tool isoften inserted through the largest diameter trocar tube (e.g. 10 mmdiameter) while a cutter, dissector, or other surgical instrument isinserted through a similarly sized or smaller diameter trocar tube (e.g.5 mm diameter) for purposes of manipulating and/or cutting the internalorgan. Sometimes it is desirable to have several trocar tubes in placeat once in order to receive several surgical instruments. In thismanner, organ or tissue may be grasped with one surgical instrument, andsimultaneously may be cut or stitched with another surgical instrument;all under view of the surgeon via the camera in place in another trocartube.

Those skilled in the art will appreciate that endoscopy is a rapidlygrowing field of surgery because it is less invasive than classicalsurgery. However, it will also be appreciated that even with endoscopicsurgery where the incisions are typically small, it is advantageous tolimit the number of incisions made. The number of incisions must bebalanced against the desirability of having several tools inserted andavailable simultaneously to the surgeon. Likewise, while it is possibleto remove endoscopic tools and insert different tools during aprocedure, it will be appreciated that repeated insertion and removal ofdifferent endoscopic tools through the trocar tubes is preferablyavoided, as it can be difficult to locate the new tool at a desiredlocation, and each insertion of a tool increases the risk of unnecessarytrauma to the surgical site area.

Some attempts have been made to provide multi-functional endoscopictools so that the number of incisions may be minimized while at the sametime providing the physician with several tools availablesimultaneously. For example, U.S. Pat. No. 4,708,136 to Saito disclosesa "Cautery Hemostatic Unit" which is deliverable through an endoscopeand includes an irrigation nozzle. Other combination endoscopic toolsare known and generally include combination suction-irrigation andsuction-cautery probes. All of these probes occupy a trocar tube when inuse and no other tools may be inserted in the trocar when occupied byone of these probes. Additional combinational tools and prototypesrecently introduced include tools which have a plurality of differentdistal end portions which can be attached and removed from a singlehandle as desired to accomplish different functions. However, thisarrangement requires repeated insertion and removal of the endoscopictool through the trocar tube to the surgical site.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide a multifunctionendoscopic instrument which includes suction and irrigation functions.

It is a further object of the invention to provide a suction/irrigationendoscopic instrument where a cautery probe is inserted through thefluid chamber of the instrument.

It is another object of the invention to provide an endoscopicsuction/irrigation/cautery instrument which permits the insertion of anadditional endoscopic tool through the instrument.

It is also an object of the invention to provide a multifunctionalendoscopic instrument having an ergonomic hand piece whereby suction,irrigation and cautery functions are easily controlled.

It is an additional object of the invention to provide an endoscopicinstrument having a progressive suction control so that the amount ofsuction is easily adjustable.

A further object of the invention is to provide an endoscopicsuction/irrigation/cautery instrument where the cautery is selectablebetween cutting and coagulating cautery voltages.

Another object of the invention is to provide a suction/irrigationendoscopic instrument where a distal end probe may be provided in adesired rotational position by insertion of the probe through theinstrument and rotation thereof while the instrument stays in place.

An additional object of the invention is to provide a cautery/irrigationsafety override mechanism which prevents the application of cauteryduring an irrigation procedure and thereby protects a patient from burnsor shocks resulting from simultaneous irrigation and cautery functions.

Yet another object of the invention is to provide a multifunctionendoscopic instrument which includes suction, irrigation, and aremovable cautery probe where the cautery probe is lockable in one ormore positions within the instrument.

Even a further object of the invention is to provide improved non-leakvalves for suction/irrigation endoscopic instruments.

Another object of the invention to provide a T-ball valve for anirrigation system having two fluid sources, where the T-ball valvepermits the flow of fluid from either fluid source but automaticallyprevents backflow from one source to the other.

A further object of the invention is to provide a number of differenttypes of probes which can be inserted into an endoscopic instrument sothat suction, irrigation, cautery and selectable other functions areavailable to the physician through a single trocar tube.

An additional object of the invention is to provide a well-built,relatively inexpensive disposable suction/irrigation/cautery endoscopicinstrument.

Another object of the invention is to provide an improved molded twopassage suction/irrigation conduit with means for carrying a cauterywire therebetween for the purpose of eliminating cable and conduittangling.

Another object of the invention is to provide a suction/irrigationendoscopic instrument having tubing already attached to the instrument,and tubing connectors for easy attachment to tubing which extends fromsuction and irrigation sources.

It is even an additional object of the invention to provide asuction/irrigation endoscopic instrument having an outer sleeveproviding a soft distal tip having cleanable side ports.

In accord with the objects of the invention, an endoscopic instrumenthaving both suction and irrigation functions is provided and generallycomprises a fluid chamber, a cannula in fluid communication with thedistal end of a fluid chamber, a slit valve and an elastomeric gasket inthe proximal end of the fluid chamber, irrigation and suction conduitscommunicating with the fluid chamber between the slit valve and thedistal end of the fluid chamber, and valves for selectively opening andshutting off the irrigation and suction conduits. The fluid chamber,slit valve, and the irrigation and suction conduits are located in apistol shaped shell, and triggers are utilized to actuate the valveswhich open and shut off the irrigation and suction conduits. Alsolocated inside the shell is an electrical circuits with an electricalcontact which contacts a metal portion of the cannula over which aninsulating sleeve is provided and which supplies a cauterizing voltagethereto. Different cautery probes are provided. The cautery probes areinserted through the slit valve in the proximal end of the instrumentand each cautery probe includes an uninsulated portion which is formedto contact the metal cannula and obtain the cautery voltage therefrom.

There are many preferred aspects of the invention which provideadvantageous features. One preferred aspect includes means forregulating the amount of suction through the cannula. The regulatingmeans includes providing the insulating sliding sleeve which covers thecannula with a plurality of longitudinally spaced distal lateralopenings, and means for sliding the insulating sleeve relative to thecannula in order to incrementally close the off the lateral openings.Several different mechanisms for causing the sleeve to slide areprovided. Another preferred aspect of the invention is a safetycautery/irrigation override mechanism. The override mechanism includesan electrical switch in the irrigation trigger which overrides thesupply of cautery voltage to the electrical contact so that no cauteryis possible while irrigating. Another safety feature relating to thecautery procedure is a probe arrangement which prevents shocks to thephysician. The probe arrangement comprises insulation which shields theprobe along its entire length up to the cauterizing distal end exceptfor a segment which contacts the cannula for electrical contact.

With the slit valve and elastomeric sealing gasket at the proximal endof the fluid chamber, fluid is prevented from exiting the proximal endof the chamber but probes or other instruments may be insertedtherethrough. For example, besides the cautery probes,irrigation-hydrodissection, injection- aspiration probes, and otherprobes are provided. One probe includes a tube with lateral holes incommunication with the fluid chamber at the irrigation conduit, and anO-ring on the probe for contacting the fluid chamber between theirrigation conduit and suction conduit openings. In this mannerirrigation is directed through the probe which extends through thecannula, and at the same time, suction is directed through the cannulaand around the probe. If the distal end of the probe is made very smallin diameter, the probe may be used for hydrodissection. Many differentprobes for accomplishing different functions are also provided. All ofthese probes are inserted through the slit valve in the proximal end ofthe instrument. The handles of all of the different probes arepreferably provided with color coded inserts so that the probe can beidentified as to type while it is located within the suction/irrigationinstrument.

Besides the ability to insert probes through the slit valve, endoscopicand laparoscopic type instruments with end effectors for grasping,cutting, dissecting, biopsy sampling, etc. may also be insertedtherethrough and through the fluid chamber. These instruments may beparticularly arranged to include an uninsulated cautery pickup, so thatthe end effectors can be used for cautery purposes. With the ability toinsert such instruments through the slit valve, surgical methods areprovided which do not require separate incisions and trocar tubes forsuction/irrigation, cautery, and manipulation.

Additional preferred aspects of the invention include: a pinch valvearrangement for the suction and irrigation conduits, including asemicircular hook for collapsing and pinching the conduit against asemicircular protrusion; a pistol shaped shell provided with a rockerthumb switch which controls the selective application of cutting andcoagulating voltages to the electrical cautery contact; a special molded"spinal cord" tubing having suction and irrigation conduits whichtogether define a rib indenture into which a cautery wire is snapped sothat the the suction and irrigation tubes and cautery wire exiting thesuction/irrigation instrument are easily managed; probes with grooveswhich interact with a locking pin provided in the shell so that probesmay be held in an inactive position in the fluid chamber; and a T-ballvalve for regulating the irrigation from two fluid sources, where theT-ball valve permits the flow of fluid from either fluid source butautomatically prevents backflow from one source to the other. Inaddition, other embodiments of aspects of the invention are provided,including a fluid chamber with only a single inlet for suction andirrigation, and a trigger mechanism utilizing poppet valves in place ofpinch valves to control suction and irrigation.

Additional objects and advantages of the invention will become apparentto those skilled in the art upon reference to the detailed descriptiontaken in conjunction with the provided figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1a is a perspective view of the suction/irrigation instrument ofthe invention showing the fluid and electrical connections of theinstrument with other portions of the invention as well as a cauteryprobe for insertion into the instrument.

FIG. 1b is a side view of the instrument of FIG. 1a with one half of theinstrument shell removed.

FIG. 1c is a detail of an indicated portion of FIG. 1a showing the slitvalve and the thumb rocker cautery/coagulation switch.

FIGS. 2a, 2b, and 2c are respectively a partially cut-away side view andside views which show the distal end of the cannula and the slidingsleeve of the instrument of FIG. 1 in first, second and third relativepositions which respectively represent a regular suction mode, and firstand second "supersuction" modes respectively.

FIGS. 3a and 3b are details of the preferred pinch valve of theinvention, showing the pinch valve causing a conduit to be inrespectively open and closed positions.

FIGS. 4a and 4b are respectively a side cross sectional view and a topcross sectional view of a preferred fluid chamber for the instrument ofFIG. 1a.

FIG. 4c is a detailed view of the cautery electrical contact coupled tothe cannula in the fluid chamber of FIG. 4a and 4b.

FIGS. 5a and 5b are cross sectional views of the preferred fluid chamberof the invention with a probe partially and fully inserted therein.

FIG. 5c is a cross sectional view of an alternative probe partiallyinserted into the fluid chamber of the invention.

FIG. 5d is a cross-sectional view of a locking mechanism for analternative embodiment for holding a probe in first and second positionsin the fluid chamber.

FIGS. 6a, 6b, 6c, and 6d are views similar to FIGS. 5a, but showingdifferent kinds of probes for effecting suction and irrigation indifferent manners.

FIGS. 7a and 7b show alternate embodiments of suction triggers andmechanisms for activating a "supersuction" mode.

FIG. 8a is a schematic diagram of the electrical circuit incorporated inand coupled to the instrument of the invention, including airrigation/cautery override mechanism.

FIGS. 8b and 8c are schematic diagrams showing how a portion of thecircuit of FIG. 8a is embodied in the shell of the instrument of theinvention.

FIGS. 8d-8g show views of a preferred cautery override switch andcircuit board used in the electrical circuit of FIG. 8a.

FIGS. 8h-8k show views of a preferred cut/coagulation cautery switch andcircuit board used in the electrical circuit of FIG. 8a.

FIG. 9a is a partially exploded cross-sectional view of a first cauteryprobe.

FIG. 9b is an enlarged view of a portion of of the probe of FIG. 9a.

FIGS. 9c-9f show the distal ends of different types of cautery probes.

FIG. 9g is a cross-sectional through another embodiment of a probe witha mechanism for permitting the probe to be extended out of the cannulaand to be withdrawn into the cannula.

FIG. 10a is a schematic views of an endoscopic tool which can beinserted through the suction/irrigation instrument of FIG. 1a.

FIGS. 10b and 10c are respectively a side view in partial cross section,and an enlarged view of the distal end the endoscopic biopsy forcepstool of FIG. 10b which can inserted through the suction/irrigationinstrument of FIG. 1a.

FIGS. 11a is a cross-sectional view of a preferred molded tubing havingsuction and irrigation conduits which together surround a rib indentureinto which a cautery wire is held.

FIGS. 11b and 11c are side and cross-sectional views of a connectorwhich mates with the molded tubing of FIG. 11a on the instrument side,and provides for separate suction and irrigation tubes and a loosecautery wire on a second side.

FIGS. 11d is a cross-sectional view of an alternative molded tubinghaving suction and irrigation conduits which together surround a ribindenture into which a cautery wire is held.

FIG. 11e is a cross-sectional view of a clip for the tubing of FIG. 11awith the tubing held therein.

FIG. 11f is a view of the clip of FIG. 11e in the direction of arrow Fthereof.

FIGS. 11g and 11h are perspective views of third and fourth embodimentsof the molded tubes having suction and irrigation conduits and a ribindenture for holding a cautery wire.

FIGS. 12a-12e show details of the T-ball valve for use in providingirrigation fluids to the instrument of the invention.

FIGS. 13a and 13b show an alternate embodiment of the fluid port andvalve portion of the invention where a single suction/irrigation port isin fluid communication with the fluid chamber, and poppet valves are inrespective first and second positions to respectively cause suction andirrigation.

FIG. 13c is a view of FIG. 13a looking in the direction of arrow Cthereof.

FIGS. 13d and 13e show a second alternate embodiment of the fluid portand valve portion of the invention where poppet valves are used inconjunction with separate suction and irrigation ports in fluidcommunication with the fluid chamber.

FIGS. 14a and 14b are cross sections of alternate fluid chambers for usewith the fluid port and valve portions of FIGS. 13a and 13drespectively.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now to FIGS. 1a and 1c, the endoscopic electrosurgicalsuction-irrigation instrument 100 of the invention is shown having apistol-shaped shell 102, suction and irrigation trigger switches 104 and106, irrigation/cautery override switch 107, cautery cut/coag rockerswitch 108, and cannula 112. The instrument 100 is connected to anelectrical source 150, a vacuum source 152 and an irrigation fluidsource 154 or sources 154, 156. A probe 500, such as an electrosurgical(cautery) probe or the like is shown located outside of the instrument100, but intended for insertion by movement as indicated by arrow "A"into and through the instrument.

In the preferred embodiment of the invention, within the pistol shapedshell 102 of the instrument 100 is a fluid chamber 114 (seen in FIGS.1b, 4a and 4b). The cannula 112 is held in the chamber 114 and extendsdistally therefrom. The proximal end of the fluid chamber is sealed by aslit-valve 118 or the like as described hereinafter. Thus, for effectingcautery or other functions hereafter described, the probe 500 isinserted through the slit valve 118 and into and through the fluidchamber 114.

With the provided suction-irrigation instrument 100, suction andirrigation are controlled by trigger switches 104, 106, andcauterization is controlled by thumb switch 108 or by foot switches (notshown) as hereinafter described. Irrigation trigger switch 106 isprovided with an electrical safety override 107 switch which disablesthe thumb switch 108 when irrigating. The shell 102 receives a suctionvacuum tube 128, an electrical supply wire 129, and an irrigation supplytube 130 via a "spinal cord" molded tubing 160 which is discussed indetail below with reference to FIGS. 11a-11d. Two sources of irrigationfluid 154, 156 may be selectively supplied to the instrument 100 byusing a T-ball valve 158 which is also discussed in detail below withreference to FIGS. 12a-12e.

Turning now to FIG. 1b, the shell 102 can be seen with trigger switches104 for suction and 106 for irrigation and a double action or rockerthumb switch 108 for electrosurgical cutting and coagulation (also shownin detail in FIG. 1c). The distal end of the body 102 is provided withan appropriately sized metal cannula 112 (typically 5 mm or 10 mm) whichis covered by an insulating sliding sleeve 110 (described in detailbelow). The proximal end of the cannula 112 communicates with the distalend of the fluid chamber 114 which is housed within the shell 102. Thefluid chamber 114 terminates at the proximal end of the shell 102 with aslit valve 118 and elastomeric sealing gasket 119. The slit valve 118and sealing gasket 119 permit probes of different types includingelectrocautery probes which are discussed in detail below to be insertedinto and through the fluid chamber 114 while still preventing fluidleakage out the distal end of the instrument. More particularly, theslit valve 118 prevents leakage when no probe or tool is insertedtherethrough, while the sealing gasket 119 (and to some extent the slitvalve) prevents leakage when a probe or tool is inserted through theproximal end of the instrument 100.

As seen in FIG. 1b, in communication with the fluid chamber 114 are thesuction conduit or tube 128 (via suction port 120) and the irrigationconduit or tube 130 (via irrigation port 122). The suction conduit 128extends through a pinch valve mechanism 124 and is coupled through atubing junction connector 134 near the base of the shell 102 to thesuction portion of the spinal cord tubing 160, and thence to vacuumsupply 152 (FIG. 1a). The suction valve 124 is operated by triggerswitch 104. As discussed below with reference to FIGS. 7a and 7b, thesuction trigger switch 104 may be divided into two switches 104a and104/104d for controlling normal suction and "super suction". Theirrigation conduit 130 similarly extends through an irrigation valvemechanism 126 and is coupled through tubing junction connector 134 tothe irrigation portion of the spinal cord tubing 160, and thence toirrigation supply 154 (156). The irrigation valve is operated by triggerswitch 106.

The suction valve 124 and irrigation valve 126 seen in FIG. 1b arestandard type pinch valves, although for larger (e.g., 10 mm)instruments, different pinch valves discussed below with reference toFIGS. 3a and 3b are preferred. The suction valve 124 is arranged with astem 171, a spring 172, a spring seat 173, a guide 174, and a valve seat175. The stem 171 is coupled to the trigger 104 and moves with thetrigger. The spring sits in the trigger 104 and is seated on the springseat 173 which is formed in the shell 102 of the instrument 100. Thus,as the trigger 104 is pressed, the trigger is acting against the forceof the spring 172 which is being compressed against the spring seat 173.The stem 171 of the suction valve 124 is preferably formed as a thinrectangular plastic piece with a large slot (not shown) in the middlewhich effectively forms a rear hook. The plastic piece is set in theguide 174 formed in the shell 102. In FIG. 1b, the suction tube 128 isshown extending through the slot in the stem 171 with the rear hookpulling, squeezing, and pinching the tube 128 against the Valve seat175. Because the suction valve 124 is set forward of the irrigationvalve, there is room for the irrigation tube 130 in the handle of theshell when the stem 171 is forced backward in guide 124 to open thesuction tube 128. In other words, with the provided arrangement, thesuction valve 124 does not interfere in any manner with the irrigationtube 130.

The irrigation valve 126 is similarly arranged to the suction valve, andincludes a stem 181, a spring 182, a spring seat 183, a guide 184, and avalve seat 185. The stem 181 is coupled to the trigger 106 and moveswith the trigger 106. The spring 182 sits in the trigger 106 and isseated on the spring seat 183 which is formed in the shell 102 of theinstrument. As the trigger 106 is pressed, the trigger acts against theforce of spring 182. The stem 181 of the irrigation valve 126 is alsopreferably formed as a thin rectangular plastic piece with a large slot(not shown) in the middle for forming a rear hook. Care is taken to makethe slot large enough to accommodate the suction tube 128 which alsoextends through the slot and which must not be pinched when theirrigation valve 126 is actuated. In FIG. 1b, the irrigation tube 130 isshown with the rear hook of the stem 181 pinching the tube 130 againstthe valve seat 185. Pressing of the trigger 106 moves the stem 181backwards and releases the tube 130 for irrigational flow.

An electrical contact 132 (shown in more detail in FIG. 4) is providedtoward the distal end of the fluid chamber 114, for connection with anelectrocautery probe as will be discussed in detail below. Theelectrical signal applied to the electrical contact 132 is controlled bydouble action switch 108 activated by a rocker mechanism 108b whichrocks over pivot 108c as described hereinafter with reference to FIGS.8h-8k. Other aspects of the instrument 100 seen in FIG. 1b include aprobe locking mechanism 136 described hereinafter with reference toFIGS. 5a-5c; a spring biased mechanism 105a, 105b for moving theinsulating sheath 110 relative to cannula 112 in order to effectsupersuction as described in more detail with reference to FIGS. 7a and7b; a spring mechanism 107a, 107b for activating cautery override switch107 as discussed in more detail with reference to FIGS. 8a-8d; and anend cap 116 for the fluid chamber as discussed hereinafter in moredetail with reference to FIGS. 4a and 4b.

As shown in FIG. 1b, even without any probe(s) inserted, the instrument100 is functional as a suction-irrigation tool. When inserted in thebody of a patient, the cannula 112 with insulating sliding sleeve 110delivers irrigation fluid when the irrigation trigger 106 is squeezed toopen the normally closed irrigation valve 126, thereby coupling theirrigation fluid tube 130 with fluid chamber 114 and thus to cannula112. Similarly, cannula 112 provides suction when trigger 104 issqueezed and the normally closed suction valve 124 opens to couplevacuum tube 128 with fluid chamber 114 and thus with cannula 112. Iftriggers 104 and 106 are squeezed simultaneously, the irrigation fluidcan be used to clean out a portion of the fluid chamber 114 as well asthe suction port 120 and suction tube 128.

Turning to FIGS. 3a and 3b, a preferred embodiment of a pinch valve 300used as the suction and irrigation valves 124, 126 of FIG. 1b is seen inthe activated open and normally closed positions. The pinch valve 300 ofFIGS. 3a and 3b is used with a resilient conduit or tubing 302 (such assuction tube 128 or irrigation tube 130 of FIG. 1b) and is preferredbecause it virtually eliminates leakage. In the activated open positionof FIG. 3a, flow through conduit 302 is permitted. In the default ornormally closed position of FIG. 3b, no flow is permitted throughconduit 302. As seen in FIGS. 3a and 3b, valve 300 comprises a hookmember 304 having a curved inner surface portion 305 conforming to theoutside diameter of resilient conduit 302, a fixed dome shaped stoppingblock 306 which has a similarly conforming but slightly smaller diametercurved portion 307, a spring 308, and an actuator 310. In the normallyclosed position of FIG. 3b (also shown in FIG. 1b) the hook 304 isbiased by spring 308 to press inward against dome block 306, whereby theresilient conduit 302 is collapsed and pinched in a curved mannerassuring a virtually complete stoppage of flow through the conduit 302.However, when the actuator 310 is squeezed against the force of spring308, the hook 304 moves away from the dome block 306 (which is fixed inposition), as the spring 308 is compressed. With the domed block 306 nolonger squeezing the resilient conduit 302, the resilient conduit 302resumes its normally round and open position as shown in FIG. 3a.

Those skilled in the art will appreciate that the actuator 310 of FIG.3a is coupled to trigger switches 104, 106 discussed with reference toFIG. 1b. In addition, the preferred embodiment of pinch valve 300 isuseful primarily when the tubes 302 are of sufficiently large diameterso as to readily collapse into an arcuate shape as suggested by FIG. 3b.With tubes of small diameter, a standard pinch valve is best used sincesmall tubes cannot readily be folded into the FIG. 3b configuration. Ineither case, however, it is desirable that the tubes 302 have arelatively thick resilient wall. In this manner, when suction triggerswitch 106 is squeezed, the trigger will travel enough distance toactivate safety override switch 107 before the valve 300 permits fluidto flow through the tube 302 (130 in FIG. 1b). In other words, theresilient tube should be thick enough so that the override switch 107 isactivated while the tube is decompressing as opposed to the walls of thetube separating from each other. This feature will be discussed in moredetail below in reference to FIGS. 8a-8d.

Details of the fluid chamber 114 of instrument 100 are seen withreference to FIGS. 4a and 4b. In the preferred embodiment of theinvention, the suction conduit 120 is located downstream (distal) of theirrigation conduit 122, and the internal diameter of the fluid chamber114 is larger in the vicinity of the suction and irrigation conduits(114a) than it is at 114b in the vicinity of the cannula 112. Onepurpose of providing a narrowing fluid chamber is to provide a seatagainst which the probes can stop. Another reason is to accommodateO-ring washers which form parts of some of the probes of the inventionas will also be discussed in detail below. However, it should beappreciated that it is not necessary that the fluid chamber narrow inthe way shown in FIGS. 4a and 4b, or that the suction conduit be locateddistal of the irrigation conduit. Indeed, the fluid chamber can beconstructed of a constant diameter, and the conduits reversed.

As seen in FIGS. 4a and 4b, the proximal end of fluid chamber 114 iscovered with an end cap 116 which houses a slit valve 118 and anelastomeric sealing gasket 119 as previously mentioned. The end cap 116is formed to mate with the proximal end of the fluid chamber 114. Thefunction of the end cap 116 is to permit the slit valve 118 and sealinggasket 119 to be inserted into the proximal end of the fluid chamberduring assembly, and to be held there during use of the instrument. Alsopreferably located at or near the proximal end of the fluid chamber 114or at the end cap 116 is a spring biased locking pin mechanism 136.Locking pin mechanism 136, as seen in more detail in FIG. 1b, preferablyincludes a pin 136a having an engaging end 136b, a circumferentialflange extending around the pin 136c, a stop 136d extending from theshell 102, and a spring 136e which is loaded between the stop 136d andthe flange 136c. As will be discussed in more detail hereinafter, thelocking pin 136a is spring biased in a position toward the fluid chamber114 and is used to releasingly mate with at least one detent on a probeso that the probe can be held in a retracted position within the fluidchamber 114.

Located toward the distal end of the fluid chamber is the electricalcontact 132 which is shown in more detail in FIG. 4c. The electricalcontact preferably comprises a washer 132a which is insert molded intothe fluid chamber 114. The washer 132a has ridges 132b and a tab 132c.The ridges 132b are used to make electrical contact with the metalcannula 112, and the tab 132c is used for electrical connection to awire coupled to a current source as discussed in more detail hereinafterwith reference to FIGS. 8a-8c.

FIGS. 5a and 5b show a probe such as a hydrodissection probe 500a whichis held in two different positions in fluid chamber 114. Thehydrodissection probe 500a is provided with a closed end proximal handleportion 502 from which a shaft portion 504 extends. The shaft portion504 is provided with lateral holes 506 and a longitudinal bore 507extending from the holes 506 to the hollow rod 510 which extends throughthe cannula 112. The longitudinal bore 507 and the hollow rod 510 are influid communication. While the distal end of probe 500a may beconfigured in a number of ways as will be described in detail below withreference to FIGS. 9a-9f, in order to be a hydrodissection probe, thehollow rod 510 of probe 500a should be extremely narrow in cross-sectionand should have a distal opening 512 at the tip of the hollow rod 510.Also, to enable the probe 500a to provide a cautery function, the hollowrod portion 510 is provided with an uninsulated bump 511 which contactscannula 112 (when the probe is in the position shown in FIG. 5a), and adistal uninsulated cauterizing surface 514. In this manner, theuninsulated bump 511 makes electrical contact with the cannula 112(which is provided with current via contact 132) and conducts thecurrent to the distal cauterizing surface 514.

In accord with a preferred aspect of the invention, the probe is alsoprovided with one or more detents 518 and 520 into which engage probelocking pin 136 can engage. As shown in FIG. 5a, when the probe 500a isfully inserted into the fluid chamber 114 so that locking pin 136engages detent or groove 520, the O-ring 508 aligns itself between theirrigation port 122 and the suction port 120. As shown in FIGS. 5a and5b, the outer diameter of the hollow rod portion 510 of the probe ismuch smaller than the inner diameter of the cannula 112 with an annularspace 516 being established therebetween. Thus, two fluid paths areestablished. In particular, the O-ring divides the fluid chamber 114into two portions, with a first portion located between the slit valve118 or gasket 119 in the end cap 116 and the O-ring 508, and the secondportion located between the O-ring 508 and the cannula 112. Theirrigation fluid supplied through irrigation port 122 is trapped betweenthe slit valve and the O-ring in the first portion of fluid chamber 114so that it is forced into lateral holes 506 where it is communicatedthrough the interior of the shaft of the probe to the distal end opening512. Suction applied through suction port 120 to the second portion ofthe fluid chamber 114, however, is directed by the O-ring to the annularspace 516 between the smaller diameter portion 510 and cannula 112.Thus, suction and irrigation may be accomplished at the same time. Also,as the bump 511 on the hollow rod is contacting the metal cannula,cautery and suction may be accomplished at the same time. Irrigation andcautery, however, cannot be accomplished simultaneously due to thecautery/irrigation override arrangement discussed hereinafter withreference to FIGS. 8a-8c.

It will be appreciated that the probe 500a may be withdrawn to a secondposition shown in FIG. 5b where locking pin engages detent 518. In thisposition, while a cautery connection is made between bump 511 andcannula 112, a cautery procedure cannot be carried out, as the distalend of the probe no longer extends through the distal end of cannula112. However, because the detents are located close to each other, theO-ring 508 still separates the fluid chamber into two portions, andirrigation may continue through the hollow rod 510, and suction maycontinue through the annulus 516. In addition, since the probe is inplace, it is readily available for use by pushing it forward to theposition shown in FIG. 5a.

In FIG. 5c, a modified cautery probe is shown so that the front lockingdetent 518a is located substantially distal the rear detent (not shownin FIG. 5c). In this situation, when the cautery probe is pulledbackward until locking pin 136 engages the detent 518a, the bump 511 onthe probe does not contact the cannula, and cautery cannot be conductedbecause the probe no longer extends through the distal end of thecannula 112 and because no electrical contact is made. In addition,irrigation and suction cannot be accomplished at the same time, as theO-ring 508 no longer separates the fluid chamber into two portions.However, with this arrangement, if the suction and irrigation triggersare activated at the same time, as previously described, a cleaning ofthe fluid chamber can be effected.

Those skilled in the art will appreciate that if desired, the functionsdiscussed above with reference to FIGS. 5b and 5c can be combined byproviding the probe with both detents 518 and 518a, so that two stopsare provided at different locations. Also, it will be appreciated thatdetent 520 is not necessarily provided, as the handle 502 can act as astop for the fully inserted position.

While the locking pin mechanism of FIGS. 5a-5c is shown schematically,it will be appreciated that the locking pin mechanism 136 of FIG. 1b ispreferred. With that arrangement, as the probe 500a is inserted into thefluid chamber, the hollow rod 510 will extend past the locking pinmechanism without touching it. However, as the shaft enters the end caparea, the taper on the distal end of the shaft will contact the lockingpin 136a and the locking pin will ride up and along the shaft and intodetent 518. The detent 518 and the end 136b of the locking pin 135a arepreferably shaped and formed in certain manners as discussed hereinafterwith reference to FIGS. 9a and 9b so that it is relatively easy to movethe probe 500a forward so as to disengage the locking pin 136a from thedetent 518 upon forward movement. Forward movement to the forwardposition causes the pin 136a to once again ride on the shaft of theprobe 500a. If a second detent 520 is provided for the most forwardposition of the probe, the pin 136a will engage in that detent. When theprobe 500a is moved backward towards its retracted position, the pin136a rides along the shaft surface and again engages detent 518.However, this time, because of the hereinafter described arrangements ofthe detent 518 and the locking pin 136a, additional backward movement ismore difficult; i.e., the lock is a better lock and requires more force.In this manner, the practitioner is made aware that the probe 500a is inthe retracted position, and a stable retracted position is established.

FIG. 5d shows an alternate embodiment of the locking pin mechanism. Inthe embodiment of FIG. 5d, pulling on the probe will not release theprobe from the locking pin. Rather, the locking pin mechanism 536requires an active release. In particular, the locking pin mechanism ofFIG. 5d, includes a locking pin 536a with a flange 536b and tab 536c, aspring 536d, a stationary spring stop or housing 536e, a lever 536f, alever pivot 536g, and a button plunger 536h having flange 536i. With theprovided arrangement, the locking pin 536a is spring biased by thespring 536d (which sits between housing 536e and tab 536c) so that theend of the locking pin 536a extends through housing 102 and can engage adetent in a probe. The flange 536b on the locking pin 536a stops thelocking pin in a defined position. When the locking pin 536a is lockedin a detent or groove of a probe, pushing on the plunger 536h (whichalso extends out of housing 102) releases the probe. The probe isreleased, because by pushing on lever 536f, the lever 536f rotatesaround pivot 536g, and pushes the locking pin 536a upwards by its tab536c against the force of the spring 536d. Upon release of plunger 536h,the spring 536d forces the locking pin 536a downward until the pin isstopped by flange 536b. Likewise, lever 536f is pushed in the oppositedirection, and pushes button plunger 536h upward until it is stopped byflange 536i.

Because the locking pin 536a is preferably angled at its tip 536j, andthe detent (as seen in FIG. 9a) of the probe is preferably similarlyramped as it extends in a proximal direction, as the probe is pushedinto the instrument, the locking pin 536a rides on the shaft, and intoand out of the detent. Upon trying to remove the probe from theinstrument, the blunt face of tip 536j will engage a shoulder on thedetent, and removal by pulling on the probe will not be effective.Removal is only obtained by activation of plunger 536h.

FIGS. 6a through 6d show some of the different types of probes which canbe used with the instrument of the invention. In particular, and withreference to FIG. 6a, a probe 600a which is similar to probe 500a (FIGS.5a and 5b) is shown, but two sets of lateral holes 606a, 607a, twoO-rings 608a, 609a, and an inner tube 605a with a distal port 613a areprovided. With the two O-rings, three chambers are established, with adistal chamber forward the O-ring 609a, a suction chamber betweenO-rings 609a and 608a, and an irrigation chamber proximal O-ring 608a.As shown in FIG. 6a, holes 607a in the probe communicate with theinterior of hollow rod or tube portion 610a of the probe which extendsthrough chamber 112. Thus, suction is accomplished through tube 610a,holes 607a and into suction port 120. Holes 606a, on the other hand,communicate with the annular space 616a in the cannula 112 via tube 605aWhich extends through the suction chamber and Opens at 613a into theannular space 616a. Thus, in this probe 600a as compared to the probe500a of FIGS. 5a and 5b, suction is applied through the smaller diameterportion of probe 610a and irrigation is supplied through the annularspace 616a; which arrangement is the opposite of what is obtained inFIG. 5a.

FIG. 6b shows yet another kind of probe 600b. In this probe, suction andirrigation are both applied through the distal opening 612b of the probe600b. Probe 600b is provided with lateral holes 606b communicating withthe interior of the probe to the opening 612b at its distal end. O-ring708b seals the fluid chamber 114 from the annular space 616b betweenprobe 600b and cannula 112. Both suction and irrigation are providedthrough holes 606b to the opening 612b at the distal end of probe 600b.

FIG. 6c shows an additional feature which can be utilized in conjunctionwith any of the previously described probes. In particular, a probe 600cis shown (similar to probe 500a of FIG. 5a) with a longitudinal bore607c which extends all the way through the shaft 604c and handle 602c.Blocking the longitudinal bore 607c in the handle (although it could beplaced in the shaft) is a slit valve 625c. As shown in FIG. 6c, anotherprobe, such as needle probe 689c, is inserted through the handle 602c,the slit valve 625c, the longitudinal bore 607c and into the hollow rod610c. Probe 689c is typically longer than probe 600c so that wheninserted in probe 600c, its distal end 691c extends through and beyondthe opening 612c at the distal end of probe 600c. The proximal end ofprobe 689c is preferably provided with a female luer slip or luer lock699c for receiving a syringe. With the provided arrangement, should aninjection of medicine through the instrument 100 be desired, or should afluid sample be required, a syringe can be coupled to the luer lock699c, and the medicine injected or fluid aspirated into the syringe.After the injection or aspiration procedure, the needle probe 689c canbe removed, and the probe 600c can remain in place without leakage outthe proximal end because of the slit valve 625c. Likewise, before theneedle probe 689c is inserted through the slit valve, and while theneedle probe is extending through the slit valve, no leakage will occureven if suction or irrigation is occurring at the same time. It will beappreciated, that if desired, a gasket (not shown) can also be used inconjunction with the slit valve 625c in the handle of the tool 600c suchthat the arrangement will be similar to the proximal end of the fluidchamber. Also, it will be appreciated that the probe 600c can take manyforms, with or without lateral ports (shown in phantom) and with orwithout O-rings as discussed above with reference to FIGS. 5a-5c. TheO-rings could serve both to center the probe 600c and to separate theirrigation and suction ports.

FIG. 6d shows yet another kind of probe 600d which has some functionalsimilarity to the probe 600c of FIG. 6c. In probe 600d, a fluid path607d is provided through the handle 602d and shaft 604d and out throughthe hollow rod 610d to the distal opening 612d, and a slit valve 625dand a luer lock 699d are provided at the distal end of the probe 600d.If desired, medication can be injected through the probe 600d, or fluidscan be sucked through the probe by coupling a syringe (not shown) to theluer connector connector 699d, with the nose of the syringe (not shown)extending through the slit valve 625d. By requiring the nose of thesyringe to extend through the slit valve 625d, the syringe will be influid contact with the fluid path 607d in the shaft 604d. It will beappreciated that if the probe 600d is made sufficiently narrow, bothsuction and irrigation can be accomplished via the annulus establishedbetween the probe and the fluid chamber (and probe and cannula). If itis desired to have the probe 600d only permit suction besides itsmedicating and aspirating functions, an O-ring can be provided betweenthe suction and irrigation ports.

It will be appreciated by those skilled in the art that yet other probescan be provided with the provided instrument. For example, a sharptrocar (e.g., a pyramidal metal trocar--not shown) can be formed as aprobe and can be inserted and locked into place (as discussed above withreference to FIG. 5c or otherwise) in instrument 100 so that the sleeve110 can act as the trocar tube. The instrument 100 with such a trocarprobe in place can then act as a trocar which is used to make a trocarincision through the skin and fascia of a patient, and into a bodycavity. Once the incision is made, the trocar probe can be released andremoved, and the suction/irrigation instrument 100 can be used asaforedescribed, with probes and/or laparoscopic and endoscopicinstruments (discussed below with reference to FIGS. 10a-10c) beinginserted therethrough, except that instead of operating through a trocartube, the sleeve 110 acts as the trocar tube. With such an arrangement,it may be desirable to eliminate the holes in the distal end of thesleeve 110. Likewise, it may be desirable to fix the sleeve 110 relativeto the metal cannula such that the sleeve 110 cannot be retracted andrub against the incision. Other arrangements, such as providing theinstrument with an extra tube (not shown) outside the sleeve 110 whichacts as the trocar tube, etc. will suggest themselves to those skilledin the art.

As mentioned above in reference to FIG. 1b, trigger switch 104 may bedivided into two portions 104a and 104/104d which control suction and"super suction". Three different embodiments for providing the "supersuction" feature are seen in FIG. 1b, FIG. 7a and FIG. 7b, and all maybe understood with further reference to FIGS. 2a, 2b, and 2c.

FIGS. 2a and 2b show the distal ends of cannula 112 and sliding sleeve11? in cross section. FIG. 2a shows the default position of cannula 112and sliding sleeve 110 when no trigger switches are being pulled. InFIG. 2a, it is seen that suction may occur through all of the holes 111in the sliding sleeve. Material sucked therethrough then proceedsthrough the distal opening in the cannula, as there is no annulusbetween the cannula and the sliding sleeve (i.e., they are in slidingcontact with one another). FIG. 2b shows an intermediate position, wheresliding sleeve 110 is retracted such that at least one hole 111 in thesliding sleeve 110 is blocked by the cannula 112, but suction can beobtained through other holes therein. FIG. 2c shows a full "supersuction" position, where the sliding sleeve 110 is completely retractedsuch that all of the holes 111 in the sliding sleeve 110 are blocked bythe cannula 112, and suction is only through the distal opening in thecannula 112.

As previously mentioned, the distal end of sliding sleeve 110 isprovided with a plurality of lateral holes 111. When sleeve 110 is inthe position shown in FIG. 2a, the suction vacuum appearing at thedistal tip of cannula 112 is diffused. When sleeve 110 is pulled back tothe position shown in FIG. 2c, the lateral holes 111 of sleeve 110 areblocked and can no longer provide suction openings. Thus, the entiresuction vacuum appears at the distal tip of cannula 112 to effect "supersuction". It will be appreciated that as sleeve 110 slides over cannula112, holes 111 will at different positions (e.g., FIG. 2b) haveincremental effects on the suction at the distal tip of cannula 112.Thus, the operation of the "super suction" feature of the invention isincremental and as the super suction trigger is pulled, suctiongradually increases until a maximum is reached.

The preferred embodiment for generating the super suction function isshown in FIG. 1b. In this embodiment, the sliding sleeve 110 is providedwith a collar 105a which is directly coupled to a super suction trigger104a. The collar 105a is spring loaded by spring 105b so that in thedefault position, the sleeve 110 assumes the position as shown in FIG.2a, and the trigger 104a is located distally relative to an extension104d on the suction trigger 104. With this arrangement, sliding sleeve110 can be moved a certain amount by pulling trigger 104a withoutengaging suction trigger 104. This may be desirable in order to cleandebris which may accumulate at the distal end of sliding sleeve 110.Continued movement of trigger 104a backward, however, will eventuallycause the super suction trigger 104a to engage the extension 104d oftrigger 104, thereby automatically activating suction. On the otherhand, the suction trigger 104 can be activated without activation of thesuper suction trigger 104a.

A second super suction embodiment is seen with reference to FIG. 7a. InFIG. 7a, the super suction trigger switch 704a is coupled to a hook 705which engages collar 705a of sliding sleeve 110. As with the embodimentof FIG. 1b, the collar 705a is spring biased by a spring 705b. The supersuction trigger switch 704a is also provided with an extending portion704c which extends over the suction trigger 704b. In this manner, theaction of pulling trigger switch 704a, which pulls back collar 705aagainst spring 705b, always causes sliding sleeve 110 to slide backward(as seen in FIGS. 2b and 2c) while at the same time causing triggerswitch 704b to open suction valve 124. As with the arrangement of FIG.1b, the pulling of trigger switch 704b will not cause the super suctiontrigger 704a to be activated.

A third embodiment of super suction can be effected without dividing thetrigger switch into two portions as shown in FIGS. 1b and 7a. In FIG.7b, the trigger switch 704 is attached to an actuator mechanism 759having two extensions 759a and 759b which are spaced apart and surroundcollar 705a with a gap being formed between collar 705a and extension orhook 759b. The collar 705a is attached to the proximal end of the sleeve110 and is spring loaded by spring 705b. In the embodiment of FIG. 7b,when trigger 704 is pulled through a distance equal to the gap betweenhook 759b and collar 705a, the suction valve is opened, but the slidingsleeve 110 is not pulled. Additional squeezing of trigger 104 beyondthat point, however, causes hook 759b to engage collar 105a and slidesleeve 110 back against spring 105b causing super suction. Thus, withthe embodiment of FIG. 7b, full suction can be obtained by squeezingtrigger 704 a first amount (fully opening the valve), while supersuction is obtained by squeezing trigger 704 even further to causemovement of sleeve 110 after the valve is fully opened.

FIG. 8a shows a block diagram of the electrical circuit used with theinstrument to power an electrosurgical probe. An electrical source 150supplies two different DC voltages through conductors 129a and 129b to athree position (A-OFF-B) switch 108 which selects either voltage A orvoltage B. Switch 108 supplies the selected DC voltage through conductor129d to safety switch 107 which is normally closed and thereby suppliesthe voltage through conductor 129e to electrical contact 132 and back toelectrical source 150 via conductor 129c. Electrical source 150 thensenses which DC voltage was selected and supplies the appropriate ACvoltage for cutting or coagulating via conduit 129c back to electricalcontact 132 whereby an electrosurgical probe receives the selectedvoltage. As seen in FIG. 1b, the safety switch 107 is opened wheneverirrigation trigger 106 is pulled, as spring 107a, which is fixed to theirrigation trigger 106 at point 107b, and anchored to the housing at107c, is provided with an actuation portion 107d which moves off of domeswitch 107 when spring point 107b is moved. Thus, cautery is interruptedduring irrigation. In this regard, it is recommended that the valvesdiscussed above with reference to FIGS. 3a and 3b and also discussedbelow with reference to FIG. 13 be provided with a certain amount oftravel before irrigation is actuated. This will ensure that the safetyswitch is opened before any irrigation fluid is allowed to flow throughthe irrigation valve. Moreover, it should be noted that this arrangementof the electrical source 150 and conductors 129a-e ensures that theactual AC cautery voltage does not pass through the switches 107, 108,thereby minimizing the risk of shock to the physician and switchfailure. Such electrical sources which are activated by DC voltage tosend a selected AC voltage are known in the art.

FIGS. 8b and 8c show examples of how this circuit is implemented in theshell of the instrument. Turning to FIG. 8a, an electrosurgical powersupply 150 provides two sources of DC voltage through conductors 129aand 129b. These voltages are selectively applied to the electricalsource 150 via conductor 129c by a three position switch 108 which inFIG. 8b is a rocker switch 108b. Switch 108 selects the desired voltageand conducts that voltage through conductor 129d to safety switch 107which is normally closed but is opened by pulling the irrigation trigger106. Safety switch 107, when closed, couples conductor 129d, electricalcontact 132 through conductor 129e, and electrical source conductor129c. Electrical source 150 then senses which DC voltage was selected byswitch 108 and supplies the appropriate AC cautery voltage throughconductor 129a, switch 107 and conductor 129e to electrical contact 132and thereby to an electrosurgical probe inserted in the shell 102.

FIG. 8c shows a similar arrangement to FIG. 8a, but with a standard footswitch 108a and a provided adapter 108c substituted for the thumb switch108 of FIG. 8a and 8b. As seen in FIG. 8c, the standard electrosurgicalpower supply 150 is provided with four output ports: a first port for a"cut" low voltage wire 129a; a second port for a "coag" low voltage wire129b; a third port for a "common" wire 129e; and a fourth port for thehigh voltage AC signal wire 129c. Likewise, the standard foot switch108a is provided with three ports, including the "cut" port, the "coag"port, and the "common" port. The primary difference between theelectrical arrangement of FIG. 8c and that of FIGS. 8a and 8b is that inFIG. 8c, the low voltage DC cut or coag signal is not sent over the samewire as the AC signal. Thus, wire 129 c is connected directly from thepower supply 150 to the cannula, and the adapter 108c is provided tointerrupt the common wire 129d/129e, so that it is routed through thecautery override safety switch 107. When switch 107 is closed, andeither the cut or coag foot switch is pressed, a DC circuit is completedfrom power supply 150, through wire 129a or 129b (via adapter 108c),through wire 129d (via adapter 108c), through switch 107, through wire129e (via adapter 108c) and back to the power supply 150. The closedcircuit signals the power supply 150 to provide an appropriate AC signalto the cannula of the instrument via wire 129c. However, when switch 107is open, the DC circuit cannot be completed, and hence no high voltageAC signal will be sent out over wire 129c.

While not preferred, it will be appreciated that in either of thedisclosed arrangements, switch 107 can be located in the AC path 129cinstead of the DC path. Such an arrangement guarantees that thevoltage/current source 150 cannot malfunction and supply current via theAC path 129c to the cannula when no DC voltage is being presented. Onthe other hand, such an arrangement places greater electrical demand onswitch 107 as switch 107 must interrupt the high voltage AC current.

FIGS. 8d-8k show preferred embodiments dome type switches which can beused for the thumb switch 108 and safety switch 107 described above. Inparticular, FIGS. 8d and 8e represent respectively a top view and abottom view of a printed circuit board 830 used in connection withdome-type safety switch 845 shown in FIGS. 8f and 8g. This switch may beused for safety switch 107 (FIG. 1b). Circuit board 830 includes wireholes 832, 834 for attaching electrical wires. Wire hole 832 issurrounded by conductive material 836 forming a circular stripsurrounding but insulated from a smaller conductive circle 838. In FIG.8e it can be seen that the small conductive circle 838 is coupled byconductive material 838a through conductive strip 840 to wire hole 834.

FIG. 8f shows a top view of dome switch 845 having a dome 842. As willbe appreciated, dome 842 is constructed of resilient material and isconductive on its side facing the top of circuit board 830 so thatpressing dome 842 electrically couples the conductive material 836 and838 thereby coupling wires attached to wire holes 832 and 834. Referringonce again to FIG. 1b, it can be seen that a dome type switch such asthe one described above my be used for safety switch 107 wherein abiasing member 107a such as a spring keeps switch 107 normally closedand where the biasing member has an engaging portion 107b which is movedby trigger 106 so as to move actuation portion 107d and open the switch107.

FIGS. 8h and 8i are respectively a top view and a bottom view of aprinted circuit board 850 used in connection with dome-type rockerswitch 880 shown in FIGS. 8j and 8k. Circuit board 850 includes wireholes 852, 854, and 856 for connecting to electrical wires. Wire hole854 is surrounded by conductive material 864 which is a straight stripconnecting two circular strips of conductive material 868 and 870. Thesecircular strips surround smaller conductive circles 872, 874. A singleconductive strip 876 surrounds wire holes 858. In FIG. 8i it is seenthat wire hole 852 is surrounded by conductive material 878 whichconnects with conductive material 874a and 874 on the top side of thecircuit board. Similarly, wire hole 856 is surrounded by conductivematerial 876 which connects with conductive material 872a and 872 on thetop side of the circuit board.

FIG. 8j shows a top view of the dome switch 880 having domes 882 and884. As will be appreciated, domes 882 and 882 are constructed ofresilient material and are conductive on their side facing the top ofcircuit board 850 so that pressing dome 882, for example, electricallyconnects conductive material 868 and 872 thereby coupling the cauterywires connected to wire holes 854 and 856. Similarly, pressing dome 884results in a coupling of conductors connected to wire holes 854 and 852.Wire holes 858 are provided as a simple hardwire connected means tocouple three conductors. Referring once again to FIG. 1b, it can be seenhow a two-dome-type switch such as the one described above can be usedfor thumb switch 108 wherein a rocker arm 108a pivots at 108b to depresseither one of the domes described above.

As mentioned above, many different kinds of probes can be used with theinstrument and more than one probe can be used together in theinstrument. FIGS. 9a-9g show additional features of probes used with theinstrument.

FIG. 9a shows a side cross sectional view of a cautery probe 900. Theprobe comprises a handle 902, from which extends a shank 904 whichcarries the probe wire or conductor 906. Handle 902 is provided with arecess 902a for receiving a color coded insert 903 which snaps in place.In this manner, the distal arrangement of the probe can be quicklyidentified by the physician during an operation either while the probeis in place, or in choosing a probe. The shank 904 is provided with atleast one locking groove 918 to secure the probe in the instrument asdiscussed above in reference to FIGS. 5 and 6, although a second groove920 may also be utilized. The probe conductor 906 is provided with abumped portion 911 for engaging the electrified cannula 112 as discussedabove, and terminates with a cauterizing surface 912 which may beconfigured in a number of ways. The probe conductor 906 is insulatedwith insulating sleeve 908 along its entire length except for the bumpedportion 911 and the cauterizing surface 912. Preferably, the bumpedportion 911 is located near the distal end of the probe to addstabilization to the probe. However, if desired, in accord with anotherembodiment of the invention, the instrument 100 is not provided with ametal cannula and a sleeve, but with only a smooth nonconductive sleevewhich acts as the cannula. With this arrangement, the bumped portion 911of probe 900 is provided close to the shank of the probe at the locationof the washer 132 (FIG. 4) so that the bumped portion 911 contacts thewasher 132 to obtain its electrification.

Referring now to FIG. 9b, the shank portion 904 of the probe 900 is seenin an enlarged view. As shown in FIG. 9b, and previously discussed withreference to FIGS. 5a-5c, the locking groove or detent 918 in probeshank 904 is configured such that it engages and easily disengages thelocking pin 136 when the probe is inserted, but does not as easilydisengage when the probe is being withdrawn from the fluid chamber. Inparticular, locking groove 918 has a first ramp 918a of decreasingdiameter as it extends distally, followed by a section of constantdiameter 918b followed by a sharply angled ramp or step 918c ofincreasing diameter. By forward movement of the probe carrier 904, thelocking pin rides on the outer surface of the probe. Upon reachinggroove 918, the locking pin snaps into the groove. Continued movementcauses the pin to ride up the gentle slope of the proximal ramp 918a andto continue riding on the outer surface of the probe shank 904. Uponrearward movement of the probe, however, the pin located in the groove920 and establishes a stable intermediate position for the probe. If itis desired to remove the probe, the pin must be forced over the step orsharply angled ramp 918c. It will be appreciated by those skilled in theart that locking groove(s) 918 (and 920) and/or locking pin 136 may beconfigured in different ways to give probes a different feel whenengaging locking pin 136.

As mentioned above, the cauterizing surface 912 of the probe 900 may beconfigured in a number of ways. Surface 912 in FIG. 9a is a ball shapedtip. FIGS. 9c-9f show respectively a hook 912a, an L-hook 912b, aspatula 912c and a spoon 912d. Other configurations will be obvious tothose skilled in the art. The color coded inserts 903 mentioned aboveare preferably used as a rapid means of distinguishing these probes whenthe probe is inserted in the instrument and not in view, or when many ofthe probes are laying together on a tray.

FIG. 9g shows another kind of probe 901. This probe has a retractableprobe conductor 906 which is slidably mounted inside a hollow opening925 of probe shank 924. Probe conductor 906 is provided with a proximalhandle 930 which is biased by spring 926 to a position wherein probeconductor 906 is somewhat retracted inside probe shank 924. Probe handle902 is provided with a hollow opening 927 which receives the proximalhandle 930 and a movable pin 928 biased radially outwards by spring 929.Proximal handle 930 is provided with lateral openings 932 through whichpin 928 passes in part but is stopped by pin stop 931 and lateralopening 932 is provided at its proximal end with a pin stop engagingrecess 933. As shown in FIG. 9g, the probe conductor 906 is retracted,and proximal handle 930 is biased outward from probe handle 902 and pin928 is biased radially out of probe opening 932. By pressing proximalhandle 930 forward into probe handle 902, probe conductor 906 is movedin the distal direction out from its retracted position shown. As aresult, spring 926 is compressed, and inner surface of lateral opening932 rides on top of pin stop 931 until pin stop 931 is positioned abovepin stop engaging recess 933. At this point, pin 928 moves radiallyoutward under the action of spring 929 and pin stop 931 engages pin stopengaging recess 933 whereby the position of proximal handle 930 islocked against spring 926 and the probe conductor 906 is locked in anextended position. It will be appreciated that the retraction of theprobe conductor 906 may be simply effected by pressing pin 928 at itstop portion which extends radially through probe handle 902, therebydisengaging pin stop 931 from pin stop engaging recess 933 and allowingaction of spring 926 to bias proximal handle 930 back to the positionshown in FIG. 9g. It will be appreciated, that in order to avoid entryof fluid into the probe 901, a fluid seal 935 such as an O-ring isprovided in the shank 924. The seal contacts the probe conductor 906,but permits the probe conductor 906 to extend therethrough.

As mentioned above, in addition to the probes specifically designed foruse with the instrument, many existing endoscopic tools can be used inconjunction with the instrument and other tools may be modified for usewith the instrument. For example, FIGS. 10a-10c show details ofendoscopic tools from coassigned U.S. patent applications Ser. Nos.07/780,013 and 07/837,046, both of which are incorporated herein byreference in their entireties.

With reference to FIG. 10a, a laparoscopic surgical tool is indicated at1000. The laparoscopic surgical tool 1000 includes an aluminum tube 1015surrounded by a peripheral insulating shrink Wrap layer of plastic 1020,a clevis means 1030, end effectors 1040, actuating means 1050, and apush rod 1060. The clevis means 1030 is preferably a separately formedaluminum piece which fixedly engages aluminum tube 1015. The clevis 1030also engages the manipulating members 1090, 1092 of the end effector1040. Members 1090 and 1092 are pivotally engaged to clevis 1030 atpivot pin 1045. The push rod 1060 is engaged at its distal end 1065 tothe manipulating members 1090, 1092, and is connected at 1070, at itsproximal end, to a manually operable actuating means 1050. As seen inFIG. 10a, (as opposed to Ser. No. 07/780,013) instrument 1000 ismodified in that a bump 1011 in the aluminum tube 1015 is provided tomake contact with cannula 112 shown and described above, and in that theinsulation 1020 is discontinued at the bump.

In use, the laparoscopy tool 1000 is inserted with the blades 1090, 1092of the end effector 1040, in the closed position, through theelastomeric gasket and slit valve and into the fluid chamber and cannulaof instrument 100 (shown and described above). Upon the distal portionof the laparoscopy tool 1000 exiting the cannula of instrument 100, oneor both of the blades 1090, 1092 can be opened and closed as indicatedby reciprocal motion of push rod 1060 which results from operation ofthe manual actuating means 1050, and the laparoscopy tool 1000 may berotated as desired. If the laparoscopy tool is sufficiently small indiameter relative to the cannula, suction and irrigation are stillavailable through the cannula 112. In addition, because of bump 1011, acautery voltage may be selectively applied to the end effector of thelaparoscopy tool 1000 through electrical contact 132 and cannula 112.Further, the laparoscopy tool 1000 may be partially withdrawn from, butleft in instrument 100 with the elastomeric gasket and slit valvesealing the fluid chamber and preventing leakage, and the laparoscopytool 1000 may be reinserted or fully withdrawn as desired. Then, othertools may be inserted through instrument 100.

With reference to FIGS. 10b and 10c, a biopsy forceps assembly 1100 isseen which is a modified version of the biopsy forceps device shown inpreviously incorporated patent application Ser. No. 07/837,046. Biopsyforceps tool 1100 has a distal end 1112 having a jaw assembly 1114, anda proximal end 1116 having a handle 1117, a spool 1119, and a thumb ring1121 for manipulation of the jaw assembly. The jaw assembly 1114comprises a pair of jaws 1118 and a clevis 1134. The jaws 1118 arepreferably investment cast, and are preferably a duplicate of the other.Each jaw 1118 has a proximal end having a tang 1124 through which a bore1166 transversely extends. In addition, jaws 1118 each include a secondtransverse bore 1130 through a middle portion of the jaw. A clevis pin1128 extends through bore 1130 and couples to the arms of the clevis1134. As seen in FIG. 10c, the clevis 1134 extends proximally into a hub1140 which also receives metal tube 1150. Metal tube 1150, as shown inFIG. 10b, is provided with a bump 1151 for cautery pickup from thecannula 112 (FIG. 1).

In order for the jaws 1118 to rotate around clevis pin 1128, they mustbe actuated at their tangs 1124. In particular, a pair of pull wires1160 are provided at their distal ends with dog's-leg bend (a Z-bend).Thus, each pull wire 1160 has a first portion 1162 which is rotatablydisposed in the recess 1126 in the tang 1124 of each cutter jaw 1118, asecond portion 1164 which extends through the bore 1166 in the mostproximal end of the tang 1124, and a ninety degree bend 1168 between thesecond portion 1164 and the main pull wire 1160. Each pull wire 1160 isalso preferably provided with a reflex curve 1170 extending betweentheir distalmost ends and the distalmost end of the tube 1150. Thereflex curve 1170 helps to open the cutter jaws 1118 when the spool 1119on the handle 1117 is displaced distally thereto.

The proximal end of the tube 1150 and the proximal end of the pull wires1160 extend into handle 1117 which is located at the proximal end 1116of the biopsy forceps assembly 1110. The handle 1117 comprises a centralshaft 1121 about which a displaceable spool 1119 is disposed. Additionaldetails of the handle may be obtained by reference to aforementionedSer. No. 07/837,046 as they do not comprise an aspect of the presentinvention. It is of note, however, that movement of the spool 1119,which is disposed about the central shaft, effectuates movement of thepuller wires 1160 disposed within the tube 1150. Because the distal endsof the wires 1160 are attached to the tangs 1124 on the jaws 1118, whilethe jaws are fixed relative to the metal tube 1150 by clevis 1134 andclevis pin 1128, movement of spool 1119 causes rotational movement ofthe jaws 1118.

In use, the jaws 1118 of the biopsy forceps tool 1100 are inserted inthe closed position through the elastomeric gasket 119 and slit valve118 and into and through the fluid chamber 114 and cannula 112 ofinstrument 100 (shown and described above). Upon the distal portion ofthe biopsy forceps tool 1100 exiting the cannula of instrument 100, jaws1118 can be opened and closed as described above by movement of spool1119. If the biopsy forceps tool 1100 is sufficiently small in diameterrelative to the cannula, suction and irrigation are still availablethrough the cannula 112. In addition, because of bump 1151, a cauteryvoltage may be selectively applied to the end effectors (jaws) of theendoscopic tool 1100 via electrical contact 132 and cannula 112.

It will be appreciated that the instrument of the present inventionoffers many advantages when used in endoscopic surgery. After providingan incision in the body and providing a trocar tube therein, theinstrument 100 of the invention can be inserted into the trocar tube tosupply irrigation and suction. Moreover, various endoscopic tools andprobes can be inserted into the instrument through the fluid chamber 114and cannula 112 as described above to perform endoscopic procedureswhile maintaining availability of irrigation and suction through thesame body incision. As described, any of these probes or endoscopictools can also be provided with electrosurgical voltages and currentsthrough the instrument by contact with the electrical contact 132.

As mentioned in reference to FIGS. 1a and 1b, and in accord with anotheraspect of the invention, an electrical supply 150, a vacuum 152, and anirrigation supply 154/156 can be connected to the instrument via asingle "spinal cord" arrangement 160 where suction and irrigation are intwo channels of a single molded plastic tube with a rib therebetweenwhich carries the cautery wires. FIG. 11a shows a cross section of apreferred spinal cord tubing 160 having an irrigation supply tube 130and a larger suction tube 128 molded together in a single piece with acylindrical groove or space 129f for receiving electrical supply wires129 (FIG. 1a). The groove 129f is mostly closed, but is provided with aslit opening 129h defined by a pair of lips 129g extending along thelength of tubing 160 so that the electrical supply wires may be insertedinto the space 129f. As seen in FIG. 11a, the size of the opening 129hbetween the lips is smaller than the diameter of cylindrical space 129f(and smaller than the diameter of the wire(s) 129). However, because thetubing and lips are elastic, the wire 129 may be forced past the lipsand inserted and held in the space 129f, and remain secure thereinalthough it is still removable therefrom.

FIGS. 11b and 11c show a connector used for coupling the spinal cordtubing 160 to separate suction and irrigation tubes and for holding theelectrical supply wires in place at their point of entry intocylindrical space 129f of the tubing 160. The connector comprises acentral block 229 having tapered couplings 230 and 228 on one side forconnection with irrigation and suction supply tubes 130 and 128,respectively, of the spinal cord tubing 160, and similarly taperedcouplings 230a, 228a on the other side for connection with individualirrigation supply tube 230b and suction supply tube 228b. The diameterof the couplings may be varied depending on the connections to be made.For example, when the connector is used inside the instrument 100 (134in FIG. 1b) the inwardly directed tapered couplings may be smaller toconnect with tubes inside the instrument.

FIG. 11c shows the connector in cross section along line C-C of FIG.11b. Here it can be seen that the aforementioned couplings have coaxialthroughbores as would be expected and the central block 229 is providedwith a wire space 229f having an opening 229g corresponding to the wirespace 129f and opening 129g of the spinal cord tubing 160. This wirespace 229f provides a convenient place to secure wires entering thespace 129f of the tubing 160. The central block may also be providedwith mounting holes, flanges and the like, for securing it in aparticular place where the individual tubes and wires are joined to thespinal cord tubing.

FIG. 11d shows an alternate embodiment of tubing 160a with suction tube128, irrigation tube 126 and a wire slot or space 129j. The differencebetween this embodiment and the one shown in FIG. 11a is that theopening 129k defined by lips 129m is on the opposite side of the tubing;i.e., the flat outer surface 160d of tubing 160 is interrupted by thelips 129m and slot opening 129k as opposed to presenting a flat outersurface as shown in FIG. 11a.

FIGS. 11e and 11f show a hanger clip 260 for securing the tubing 160 tothe edge of an operating table or to a hanging post such as those usedfor IV bottles and the like. The hanger 260 comprises a resilient stripof metal or plastic shaped to conform somewhat to the round sides of thetubing by rounded portions 260a and 260b terminating in curved ends 260cand 260d. The tube is inserted into the clip by pulling the curved ends260c and 260d apart and snapping the tube 160 through the space createdbetween these ends. The resiliency of the clip and its conformity to theshape of the tube make it fit snugly around the tube. One end of theclip is provided with a hook like member 260e for hanging as statedabove. Alternatively, the hook-like member 260e may be replaced with aspring-action grasping clamp or an adhesive strip or pad to allow theclip to be attached to the surgical drapes or to the operating table.

The hanger clip 260 or the like may also be used in conjunction with thetubing embodiments seen in FIGS. 11g and 11h. In FIG. 11g, a moldedtubing 1560 is provided with a suction tube 1528, and an irrigation tube1530. The tubes are joined at a thin junction 1570 which is defined bythe meeting of the suction and irrigation tubes at points 1571a and1571b. As seen in FIG. 11g, the thin junction 1570 is made sufficientlynarrow such that the suction and irrigation tubes can be peeled apart.In addition, as seen in FIG. 11g, the irrigation tube has resilientextensions or lips 1540a, and 1540b which help define a lumen 1529 for acautery cable having an opening 1540c which is smaller than the diameterof the cautery wire to be held in the lumen. In this manner, the wire(not shown) can be snapped into place and held in place, or removed asdesired. It will be appreciated that the resilient lips are provided onthe irrigation tube because the irrigation tube is preferably smallerthan the suction tube, and so the overall diameter of the tube portionhousing the irrigation tube and cautery lumen will be relatively closein size to the size of the suction tube portion. Of course, if desired,the lips defining the cautery lumen could be provided on the suctiontube rather than on the irrigation tube.

Turning to FIG. 11h, a tubing 1660 which is similar to that of FIG. 11gis provided, except that instead of providing an integral single plastictubing, two tubes 1628 and 1630 are provided. Suction tube 1628 is shownwith lips 1671a and 1671b which define a thin channel. Irrigation tube1630 is shown with a protrusion or knob 1670 which mates with the thinchannel along its length. In this manner, the irrigation tube andsuction tube 1628 are held together, but can easily be divided as shown.As with the embodiment of FIG. 11g, the suction tube 1630 is alsoprovided with resilient lips 1640a and 1640b which define a lumen 1629for a cautery cable, with the lumen having an opening 1640c which issmaller than the diameter of the cautery cable. In this manner, thecautery cable can be snapped into place, or divided out from theirrigation lumen as desired.

The tubings 160, 160a of FIGS. 11a and 11d (as well as tubings 1560 and1660 of FIGS. 11g and 11h) provide a distinct advantage over the priorart in that a jumble of wires and tubes exiting instrument 100 isavoided. In addition, by providing a clip such as shown in FIGS. 11e and11f, issues regarding the sterile field can be avoided, as the clip canbe positioned at a point on operating room table where sufficient lengthof tubing for flexibility is provided, and that tubing will all bemaintained in the sterile field, while all tubing beyond the clip willbe assumed to be located out of the sterile field.

As mentioned above in reference to FIG. 1a, and according to a furtheraspect of the invention, a T-ball valve is provided to couple twosources of irrigation fluid to a single irrigation supply tube. FIGS.12a-12e show details of such a T-ball valve, and it can be seen that theT-ball valve 158 preferably comprises three fluid chambers 952, 958, and964 and a ball chamber 960. Ball chamber 960 is separated from fluidchamber 952 by a shoulder 954 having an inclined edge 956 facing ballchamber 960 so that the ball 972 will not enter fluid chamber 952 butmay sealingly seat against the inclined edge 956 of shoulder 954. Ballchamber 960 is separated from the fluid chamber 964 by a narrowconnecting piece 962 which is shown clearly in FIG. 12b (which is across section along line B--B of FIG. 12a) and is provided so that theball will not enter chamber 964. Of course, other means such as bumps orprotrusions (i.e., partial connecting pieces 962) can be used for thissame purpose. In the preferred embodiment, fluid chamber 958 isdimensioned to be larger than fluid chamber 952 so that it can receivean insert 966 (FIG. 12d) after the ball 972 is placed in the ballchamber 960. The insert 966 has inner dimensions similar to the fluidchamber 952 with a shoulder 968 having an inclined edge 970 facing ballchamber 960 so that the ball 972 will not enter fluid chamber 958 butwill sealingly seat against inclined edge 970. As shown in FIG. 12e,ball 972 is seated against inclined edge 956 thereby sealing off fluidchamber 952 so that fluid from chamber 958 may enter chamber 964 withoutentering chamber 952. It will be appreciated that when ball 972 is inits opposite position against inclined edge 970, fluid from chamber 952may enter chamber 964 without entering chamber 958.

Referring back to FIG. 1a, it will be appreciated that when theirrigation fluid supply 156 is opened to enter T-ball valve 158, theball 972 in the valve will seat against inclined edge 970 sealing thefluid chamber 958 so that fluid from fluid source 156 does not enter thetube leading to fluid source 154. When fluid in fluid source 156 isexhausted and fluid source 154 is opened, the ball 972 will be forced bythe fluid entering chamber 958 to seat against inclined edge 956 therebysealing chamber 952 and preventing fluid from fluid source 154 fromentering fluid source 156.

As mentioned in reference to FIG. 1b, the shell 102 of instrument 100includes trigger switches operating valves for suction and irrigation.One type of valve was shown and discussed in reference to FIGS. 3a and3b. FIGS. 13a -13c and 13d-13e show two other types of valve arrangementwhich can be used with alternate embodiments of fluid chamber as will bediscussed in detail below with reference to FIG. 14a and 14b.

Referring now to FIGS. 13a and 13c, a valve assembly 1300 includes asuction conduit 1302 which is coupled to a vacuum source (not shown), anirrigation conduit 1304 which is coupled to a source of irrigation fluid(not shown), and single port 1306 connected to the fluid chamber 1414a(FIG. 14a), and two poppets having disks 1308 and 1310, and stems orrods 1312 and 1316. Valve disks 1308 and 1310 are preferably providedwith 0-ring seals 1309, 1311 around their outer surfaces. Valve disk1308 is shown in the path which connects the suction conduit 1302 withport 1306, and valve disk 1310 is shown in the path which connects theirrigation conduit 1304 with port 1306 via Connecting space or chamber1320. The poppet valve disks 1308 and 1310 are operable by poppet valvestems or rods 1316 and 1312 which are biased by springs 1377 and 1379 inthe triggers (see FIG. 1b). Thus, the suction trigger 104 (FIG. 1b) isattached to stem 1312 to operate poppet valve disk 1308, and irrigationtrigger 106 is attached to poppet stem 1316 to operate poppet valve disk1310. The valve assembly 1300 includes holes 1381, 1383 and chambers1385, 1387 housing 0-rings 1391, 1393 through which the stems 1312, 1316extend, to prevent leakage out through the trigger mechanism.

By comparing FIGS. 13a and 13b, it is seen that irrigation valve disk1310 is movable from a first position shown in FIG. 13a where irrigationconduit 1304 is sealed from the fluid chamber 1320 (and hence from fluidport 1306) to a second position shown in FIG. 13b. In FIG. 13b, theirrigation fluid passes from inlet 1304 to chamber 1320 and, if valveseal 1308 is in the closed position as it is in FIG. 13a, up into port1306. Likewise, suction valve disk 1308 is movable from a first positionshown in FIG. 13a where the suction conduit 1302 is sealed from the port1306 to a second position shown in FIG. 13b where the suction conduit1302 communicates with the port 1306, and chamber 1320 is sealed offfrom the port 1306. It is noteworthy that when the suction trigger isfully depressed, the chamber is sealed off so that no suctioned materialenters chamber 1320 to be later mixed with irrigation fluid and/or clogthe valve. If desired, a seat 1324 (shown in phantom) may be provided asa back stop for disk 1308 in order to provide a more secure closureagainst the possibility of suctioned materials entering chamber 1320. Itshould be appreciated, that with the valve assembly arrangement of FIGS.13a-13c, that if it is desired to clean the chamber 1320 and/or suctionconduit 1302, the triggers for the suction and irrigation may be pressedat the same time, with the suction valve only partially opened. Thiswill cause a flow from irrigation conduit 1304 past valve disk 1310 andinto chamber 1320, and then around and past valve 1308 and down suctionconduit 1302.

The fluid chamber 1414a of FIG. 14a, which in most respects is the sameas fluid chamber 114 discussed above with reference to FIGS. 1b, and4a-4b, is provided for the valve assembly 1300 of FIGS. 13a-13c. As seenin FIG. 14a, fluid chamber 1414a has a single combinedsuction-irrigation port 1306. The provision of a fluid chamber with asingle port for both suction and cautery permits the fluid chamber, andthus the entire instrument to be made smaller.

FIGS. 13d and 13e show yet another embodiment of a poppet valve assemblywhich may be used with yet another embodiment of the fluid chamber 1414bof FIG. 14b which will be discussed in below. The embodiment of FIGS.13d and 13e is similar to the arrangement of FIGS. 13a-13c, except thatin this embodiment, there are two ports 1340a and 1340b leading to fluidchamber 1414b, and no common chamber 1320. In particular, a suctionpoppet valve, having a disk 1308 and a stem 1316 is provided in the pathof suction conduit 1302, 1332a. Suction conduit 1304 is coupled to avacuum source (not shown), and the conduit outlet 1332a is coupled viafluid chamber port 1340a to the fluid chamber 1414b. Poppet valve disk1308 is biased in a closed position by spring 1377 which is connected totrigger 104 (see FIG. 1b), and the disk 1308 is provided with an O-ring1309 to seat in the normally closed position against a seat 1341a at oneend of the valve chamber 1319a. Valve chamber 1319a is provided topermit the travel of disk 1308 out of the suction conduit path 1322a,1302.

The irrigation system in the poppet valve assembly of FIGS. 13d and 13eis similar to the suction system. An irrigation valve, having a disk1310 and a stem 1318 is provided in the path of irrigation conduit 1304,1322b. Irrigation conduit is coupled to an irrigation source (notshown), and the irrigation outlet 1322b is coupled via fluid chamberport 1340b to the fluid chamber 1414b. Poppet valve disk 1310 is biasedin a closed position by spring 1379 which is connected to trigger 106(see FIG. 1b), and the disk 1310 is provided with an 0-ring 1311 to seatin the normally closed position against a seat 1341b at one end of thevalve chamber 1319b. Valve chamber 1319b is provided to permit thetravel of disk 1310 out of the irrigation conduit path 1322b, 1304.

As seen in FIGS. 13d and 13e, the suction port 1340a is angled relativeto fluid chamber 1414b, while the irrigation is not so angled. The angleof suction port 1340a is purposely provided so that the flow through theport 1340a, the outlet 1332a, and conduit 1304 is a straight path. Inthis manner, clogging of the port or conduit is best avoided. Also, themanufacturing process will be considerably easier. On the other hand,because the irrigation path will not clog, the tortuousness of the pathis not of particular concern. Thus, the irrigation path is chosen simplyto reduce the size of the apparatus.

FIG. 14b shows another fluid chamber 1414b which is in most respects thesame as fluid chamber 114 discussed above, but where irrigation conduitport 1340b enters from the bottom and suction port 1340a enters in anangled manner from the side. The angled suction port configurationpermits an offset between fluid conduits which eliminates suction flowpath tortuousness, and provides a compact assembly.

There have been described and illustrated herein several embodiments ofan endoscopic suction-irrigation instrument with electrosurgicalcapabilities, probes for use with the instrument, valves, circuits,switches, and connectors. While particular embodiments of the inventionhave been described, it is not intended that the invention be limitedthereto, as it is intended that the invention be as broad in scope asthe art will allow and that the specification be read likewise. Thus,while a particular pistol shape for the instrument shell has beendisclosed, it will be appreciated that many other shapes could be usedwith similar results. Also, while particular configurations of triggersand switches have been shown, other actuating means may easily beadopted for use with the invention. Moreover, while the fluid chamberhas been described in several embodiments as including a locking pin, anelectrical contact and a slit valve, it will be appreciated that thelocking pin and electrical contact could be provided outside the fluidchamber and other types of valves could be substituted for the slitvalve, even though the slit valve is particularly advantageous. Further,while several different probes, each with different features have beendisclosed, it will be appreciated that the features of different probesmay be combined in many different ways to provide even more types ofprobes for use with the invention. Likewise, while particular endoscopicand laparoscopic tools were shown as modified for insertion into thesuction/irrigation instrument of the invention so as to effect cautery,it will be appreciated that the instruments need not be modified, andthat numerous other tools could be used in conjunction with thesuction/irrigation instrument of the invention, with or withoutmodification as desired. Further yet, while it will be appreciated thatthe preferred materials for the tubing of the disclosed instrument isKraton (a thermoplastic elastomer), and that the preferred materials forthe fluid chamber, shell, triggers, etc. is ABS (acrylonytrile butadienestyrene), other materials could be utilized. It will therefore beappreciated by those skilled in the art that yet other modificationscould be made to the provided invention without deviating from itsspirit and scope as so claimed.

What is claimed is:
 1. An endoscopic suctioning instrument, comprising:a) a hollow cannula having a proximal end and a distal end; b) a sliding sleeve having a proximal end and a distal end and a longitudinal axis, said sliding sleeve being coaxial to and closely surrounding and slidingly engaging said hollow cannula, said sliding sleeve having a plurality of lateral holes at its distal end with said lateral holes being spaced along said longitudinal axis; c) valve means for selectively coupling a suction source to said proximal end of said cannula; d) sleeve actuation means means coupled to said sliding sleeve for sliding said sliding sleeve from a first position where said distal end of said sliding sleeve extends beyond said distal end of said cannula such that a first number of said plurality of lateral holes are unblocked by said cannula, to a second position where said distal end of said sliding sleeve extends beyond said distal end of said cannula such that a second number of said plurality of lateral holes are unblocked by said cannula, said second number being less than said first number, to a third position where said cannula blocks all of said lateral holes of said sliding sleeve; e) valve actuation means coupled to said valve means for opening and closing said valve means, wherein the sliding of said sliding sleeve from said first position to said second position to said third position when said suction tube is coupled to said cannula by said valve means, incrementally increases suction through said distal end of said sleeve as said lateral holes are sequentially blocked by said hollow cannula; and f) cooperation means acting between said sleeve actuation means and said valve actuation means such that actuation of one of said sleeve actuation means and said valve actuation means is effected by actuation of the other one of said sleeve actuation means and said valve actuation means.
 2. An endoscopic suctioning instrument according to claim 1, wherein:said cooperation means comprises a collar, on said sleeve actuation means, having a radial extension, and said cooperation means further comprises an engagement means, on said valve actuation means, for engaging said radial extension of said sleeve actuation means, wherein said valve actuation means is movable from a first valve position in which a connection between said suction source and said cannula is closed, to a second valve position in which said connection between said suction source and said cannula is at least partially open but said engagement means does not engage said radial extension of said collar, to a third valve position in which said engagement means engages said radial extension of said collar and incrementally to a fourth valve position with said engaging means engaging said radial extension in which said lateral holes are sequentially blocked by said hollow cannula.
 3. An endoscopic suctioning instrument according to claim 2, wherein:said collar is located at a proximal portion of said sliding sleeve.
 4. An endoscopic suctioning instrument according to claim 2, further comprising:a spring means seated against said collar and spring loading said sliding sleeve in a distal direction.
 5. An endoscopic suctioning instrument according to claim 2, wherein:said valve actuation means comprises a trigger means, wherein said trigger means includes said engagement means, said engagement means extending from said trigger means along an axis parallel to said longitudinal axis.
 6. An endoscopic suctioning instrument according to claim 1, wherein:said cooperation means comprises a collar, on said sleeve actuation means, having a radial extension, and said cooperation means further comprises an engagement means, on said valve actuation means, for engaging said radial extension of said sleeve actuation means, wherein said valve actuation means is movable from a first valve position where said engagement means does not engage said radial extension and a connection between said suction means and said cannula is closed by said valve means, to a second valve position where said engagement does not engage said radial extension and said connection between said suction means and said cannula is at least partially open, to a third valve position where said engagement means engages said radial extension and said sliding sleeve is in said second position.
 7. An endoscopic suctioning instrument according to claim 6, further comprising:a spring means seated against said collar and spring loading said sliding sleeve in a distal direction.
 8. An endoscopic suctioning instrument according to claim 6, wherein:said engagement means comprises a first radial extension, said first radial extension being distal and spaced from said radial extension of said collar when said sleeve actuation means is in said first position.
 9. An endoscopic suctioning instrument according to claim 8, wherein:said valve means comprises a trigger means, wherein said trigger means includes said engagement means, said engagement means having a longitudinal portion extending from said trigger means along an axis parallel to said longitudinal axis, and said first radial extension extending radially from said longitudinal portion.
 10. An endoscopic suctioning instrument according to claim 9, wherein:said engagement means further comprises a second radial extension, said second radial extension being spaced from said first radial extension, and said second radial extension being proximal said radial extension of said collar.
 11. An endoscopic suctioning instrument according to claim 10, further comprising:a spring means seated against said collar and spring loading said sliding sleeve in a distal direction.
 12. An endoscopic suctioning instrument according to claim 1, wherein:said valve actuation means is movable from a fully open position to a fully closed position independently of said sleeve actuation means, and said cooperation means comprises a flange, on said sleeve actuation means, means for contacting a portion of said valve actuation means and moving said valve actuation means.
 13. An endoscopic suctioning instrument according to claim 12, wherein:said flange means contacts said valve actuation means such that said valve actuation means moves whenever said sleeve actuation means is actuated.
 14. An endoscopic suctioning instrument according to claim 13, wherein:said sleeve actuation means comprises a collar having a radial extension, and said valve actuation means includes engagement means for engaging said radial extension of said sleeve actuation means.
 15. An endoscopic suctioning instrument according to claim 12, wherein:said sleeve actuation means comprises a collar having a radial extension, and said valve actuation means includes engagement means for engaging said radial extension of said sleeve actuation means.
 16. An endoscopic suctioning instrument according to claim 15, further comprising:a spring means seated against said collar and spring loading said sliding sleeve in a distal direction, wherein said collar is located at a proximal portion of said sliding sleeve.
 17. An endoscopic suctioning instrument according to claim 16, wherein:said valve actuation means comprises a trigger means, wherein said trigger means includes said engagement means, said engagement means extending from said trigger means along an axis parallel to said longitudinal axis. 